Counselors say the challenge is to convince women that they can actually overcome their addiction if they submit to treatment. That requires a close relationship with a drug counselor and regular drug screening.

"One way to understand addictions is that people do things that don't make sense, because the compulsion to use makes them do things to do damage to themselves and other people," said Dr. Toby McCoy, director of the Duke Family Care program.

Offered through Duke's department of psychiatry, the program treats mothers and moms-to-be regardless of their ability to pay.

After a relapse and losing her children for a second time, Smith gave the program another try.

"I was so focused on getting my kids back (that) I wanted them back before I could work on myself," she said. "I learned that I had to work on myself before I could get my kids back."